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HomeMy WebLinkAboutContract 45811 (2)TX EMTF MOA, 09/25/2012 TTES EMERGENCY MENCC TASK FORM '. rMRS_ CMTRACT R110, Inn RESOURCE MEMOIIANDUM OF AGREEMENT This Texas Emergency Medical Task Force Memorandum of Agreement ("TX EMTF MOA") is entered into by and between a Department of State Health Services designated Lead Regional Advisory Council ("Lead RAC") North Central Texas Trauma Regional Advisory Council (NCTTRAC), properly authorized to do business in the state of Texas, and City of Fort Worth as a Resource hereafter referred to as Resource that wishes to participate as a member of Emergency Medical Task Force ("EMTF") in Region 2 (collectively, "the Parties"). TERM Ongoing until cancelled by either party with notice to the other. 1) Purpose: The purpose of this TX EMTF MOA is to establish a mechanism for the utilization and coordination of emergency medical resources and assets in the event of an emergency or disaster, for training purposes, or any other purpose as determined by the Lead RAC, EMTF Region, or DSHS. Assets may be those in the possession of the Hospital Preparedness Program (E1PP) "Contractor" or "Subcontractors," as well as others identified through local and regional planning efforts and subcontractor agreements. Additional purpose statements are included in subsequent sections, appendices, and addenda of this document that relate to specific equipment, supplies, and personnel. 2) Activation Documentation: ) Activation 1) This agreement may be activated for a State tasked deployment, only by written notification (the "State Mission Assignment") by the designated DSHS SMOC Director or his/her designees. 2) This agreement will be activated by written notification (the "State Mission Assignment79) by the designated Lead RAC official. 3) Activation, pursuant to this TX EMTF MOA, may occur at any time, day or night including weekends and/or holidays, only after an official written State Mission Assignment has been sent to the designated Agencies contact(s). 4) The Resource acknowledges that assets and/or resources may be requested for activation for any purpose in Section 1. 5) Lead RAC will reimburse the Resource=thamount •Bided to the Lead RAC by OFFICIAL RECORD ©ITV SECRETAR' t V 0 WORTH, TX ECEh/ED AUG 2JW; I'X EMTF MOA 09/25/2012 DSHS, after submission of completed required documentation per this agreement, for actual costs allowable by DSFIS incurred in order to make the assets and/or resources ready for deployment and all allowable costs incurred under the State Mission Assignment, from the time of activation through demobilization as per the Reimbursement section of this agreement (Section 5). 6) The Resource must acknowledge receipt of the State Mission Assignment within one (1) hour and must accept or decline the Mission within two (2) hours of receipt. Upon acceptance of the State Mission Assignment the Assets must be enroute to the designated mission within the parameters of the State Mission Assignment. 7) For cost reimbursement purposes, the Mission will start when the Asset is activated to be "made -ready" for deployment and will conclude at the time the deployed Asset is ready for re -deployment from its home base after the Lead RAC issues a Demobilization Order or the terms of the State Mission Assignment have been met 8) The State Mission Assignment will include, at a minimum, the following: (a) Authorization to activate; (h) List of resources or assets requested; (c) Number and qualifications of personnel for the activation• (d) Reimbursement processes foi personnel & resources activated, including backfill as defined in Appendices A-D. (e) Description of activities (including purpose, location to report, etc.); and (f) Expected duration of the deplo} ment. B) Documentation Within four (4) hours of acceptance of the activation, the Resource will receive the official packet containing the State Mission Assignment and reimbursement forms. 3) Terms & Community Support: A) 'Terms I) The Lead RAC shall: (a) Activate sufficient In -place assets, to include personnel, to effectively implement the State Mission Assignment (b) Efficiently notify and deploy Agencies as defined in the State Mission Assignment. (c) Ensure all Agencies have a current, executed TX EMIT MOA in place at the time of Activation. (d) Assure detailed records of expenditures and time spent by Deployed and In -place Assets are complete, accurate, and have adequate supporting documentation as determined by DSI IS (e) Establish and maintain a roster of all deployed personnel and resources to facilitate accountability. (f) Maintain a list of Resource contacts and back-ups for Activation and Mutual Aid purposes, including name, e-mail address, and primary/secondary phone numbers. (g) Maintain a list of 24/7 contact information for all activated Agencies. 7 TX I;MTI4 iv1OA 09/25/2012 2) The Resource shall: (a) Certify that all assets (personnel, resources, and equipment) meet all licensing, tlaillillb and certification requirements related to his/her/its particular profession and/or mission. (b) Make necessary travel arrangements for its deployed assets. 'Travel reimbursement will be at State of "Texas rates unless otherwise agreed in writing prior to deployment. (c) Ensure deployed personnel are rostered as employees of the Resource. 3) Term of this agreement (a) 'I'elm of this agreement shall begin on the date TX I;MTI: MOA is signed by the second of the two Parties. 'This '1'X EMTI4 MOA may be terminated by either Party with thirty (30) days written notice to the other Party. 13) Community Support 1) This agreement is not intended to replace any mutual aid agreements or compacts that a Resource legally has in place in support of its community. 4) Legal Liability & General Financial Liability: A) Legal Liability 1) Resource shall have no right, and does by this agreement waive its right, to file a claim(s) against llSIIS, the State of Texas, and the Dead RAC for any personal or property injuries, d Images or requests fbi State subrogation for any tort that they may incur during activation or arising therefrom, or any other claims filed against them as a result of their activities during activation. I)SITS, the State of Texas, and the bead RAC do not waive any immunity from suit or liability that they Inay have under state/federal laws and the Texas constitution notwithstanding the above. 'I o the extent that Resource is a local governmental entity, unit of State government, or a Texas political subdivision, the waivers provided herein are further subject to state law and the 'Texas constitution which may make them unenfbrceablc in whole or in part. 2) Resource shall assume icsponsihility for Liability claims, malpractice claims. disability claims, workers' compensation claims, attorneys' fees, and other incurred costs. 3) Resource shall assume responsibility for their own acts of negligence. I3) Financial Liability 1) "The Resource, shall continue to assume legal and financial responsibility of the personnel and equipment during the time of activation or deployment. 3 TX LM'1'F MOA 09/25/2012 5) Reimbursement: A) Summary DSIIS, in conjunction with the FMTF program, is committed to timely reimbursement of EMS agencies and other entities that provide resources and personnel in times of disaster activation. Tile steps below outline the process for DSI IS to reimburse the provider within 45 days after a complete and accepted reimbursement packet is received at DSI IS. EMS agencies are encouraged to file their reimbursement packets through their bead RAC as quickly as possible to ensure timely reimbursement from DSIIS and no later than 6 (six) months after the demobilization. The 45 day reimbursement timeline will begin only after a completed and accepted reimbursement packet is accepted at 1)SITS. B) Process 1) The Resource submits reimbursement packet to the Lead RAC 2) Lead RAC review the Packet for completeness (a) If complete, the I,cad RAC will invoice DSIIS and include the packet for reimbursement (h) If not complete, the Lead RAC will work with the Resource to complete the packet then submit and invoice with the packet fbr reimbursement. 3) DSFIS will review the packet received (a) If complete, DSIIS will provide reimbursement to the I,ead RAC. (b) If incomplete, (i) I)SHS will work with the Lead RAC, or directly with the Resource if appropi late, to identify the corrective action needed. (ii) Once complete, DSIIS will provide reimbursement to the Lead RAC. (c) After receipt of the ieimhursenicnt from DSI IS, the Lead RAC. will provide reimbursement to the Resource. 6) Credentialing: A) The Resource shall certify that all personnel meet all licensing, training and certification requirements related to his/her particular profession and/oi mission. 13) When responding to a licensed hospital/healthcare facility, the authorized administrator (or designee), of the requesting/impacted facility, shall be responsible for providing a mechanism for granting emergency credentialing privileges for physicians. nurses, and other licensed or certified healthcare providers tc provide services. 4 'l'X I:MTF MOA 09/25/2012 7) Ambulance Strike Teams: A) Purpose: 1) The purpose of this section is to establish a mechanism to mobilize properly staffed and equipped Ambulances to be deployed in an Ambulance Strike 'Tam (AST) configuration (five (5) ambulances and an AST header) or other configurations as deemed appropriate lot the mission (i e. individual ambulance resources) as provided for in this TX LM'I F MOA. 2) The Lead RAC has been tasked to enter into M()t1/MOAs with EMS Agencies to piovide a minimum of five (5) ASTs from its LMTI regional area. B) `I erms for Agencies; 1) The Resource and its assets must meet the following criteria: (a) Must be I)SI IS Licensed EMS Provider (b) Must have at least twelve (12) months of experience providing local and/or long distance emergency medical services to live human beings in the State of Texas. (c) Must maintain a business office within the boundaries of the State Of Texas. (d) Must adhere and abide by all federal, state and local laws and must adhere and abide by the Texas I icalth & Safety Code, Chapter 773, Emergency Medical Services and the 'Texas Administrative Code, Title 25: health Services, Chapter 157: Emergency Medical Care during the time of its deployment to provide mutual aid in a pending or actual disaster and must adhere and abide by all Iaws and rules at all times. (e) Must keep detailed records (utilizing the I)SIHIS and/or bead RAC packet of documents/forms) of the services requested and fulfilled, and provide those records as requested, to the Lead RAC to include, but not be limited to: (i) Patient Care Records; (ii) Patient demographics, including patient(s) insurance information" (iii) A. 'I hue Log Record form of activities (f) Must keep all receipts of expenditures during deployment, and submit all requested information for reimbursement on the provided documentation for prompt reimbursement under this "I'X EMIT MOA. (g) Must he required to be sulfa -sufficient for 72 hours and should he aware that personnel could be living in austere field conditions. (h) Resource must meet I)SI IS requirements for minimum, lawful staffing per that USIIS licensed ambulance level. (i) This TX EM"IT MOA calls for each ambulance to have the minimum number of individual crew members as required by license. per vehicle deployed. Additional crew or support staff members, and any vehicles they may require, must be included in the State Mission Assignment to he eligible for reimbursement. (I) The I)SI IS Licensed ambulance provider must bill primary sources of 5 TX EM'I'I' MOA 09/25/2012 reimbursement, such as Medicaid. Medicare, private insurances or third party providers before sending 'in invoice to the bead RAC. The I)SI IS Licensed ambulance provider must submit to the Lead RAC within ninety (90) days proof of denial, proof of payment, or request for reimbursement for each patient that is transported. ** This requirement may only be excused by DSI IS issuing a statement or memorandum of such to the bead RAC for this fictivation. The provider must reimburse DSI IS if they receive primary source or third party reimbursement after receiving payment from DSI IS. (k) EMS Piovider will be reimbursed at the iates in Appendix A. 8) Professional Staff: A) Purpose: I'he purpose of this section is to establish a mechanism whereby certified or licensed professional medical or support staff may he deployed to provide various clinical or support services as requested by the Lead RAC. Ii) Description 1) As the I,ead RAC enters into FVIOt I/MOAs with DSI IS EMS Providers for EMS Staffing. I'he following list is representative of the principle tasks EMS Personnel might be activated to accomplish: (a) Medical support piovided on buses (coach type bus or school bus) designated to evacuate individuals with medical needs (estimated to be from 2 to 5 EMS Personnel and/or nursing staff pet bus). Bus evacuees will primal ily be from hospitals. nursing homes, or are the general public who have medical needs and require medical oversight during evacuation, but do not meet ambulance transport criteria. (b) Field supervision or ASTI,s who will manage Ambulance Stiike teams comprised of 5-7 ambulances and or AMBUS(es) and will report to the appropriate Incident Command structure. (c) Uniquely tasked EMS personnel who will solve at any level in the Governor's Division of Emergency M•inagement Incident Command structure as assigned. 'Phis could include an air/ground coordination team in a DDC, Medical Incident Support Team (M-IST) members, the State Operations Center or Medical Operations (`enter, a Ref,ional Medical Operations Center. or in the disaster zone, and will he responsible for managing strike team leaders, task forces, and some individual ambulance assets. (d) Ambulance staging management and support. 2) As the Lead RAC enters into subcontracts with other entities or individuals to provide piofessional medical staffing (physicians, nurses, other medical professionals), technical ind support services that would he used in the deployment of any asset requested by DSI IS the EMIT Region or the bead RAC, the following List is representative of the types of assets tint might be activated to accomplish the mission: (a) Mobile Medical Units (MMlls) as outlined in this agreement. (b) Othei mobile shelters vehicles, or trailers that may he used for command, communications, storage rind any other identified reason in support of the mission identified by DSI IS. 6 TX EMIT MOA 09/25/2012 C) Terms for Resource; 1) The Resource and its assets must meet the following criteria: (a) If the Professional Staff is deployed to provide patient care, his or her organization must have at least 12 months of continuing experience providing medical services to live htunan beings in the State of Texas or being an employee of an existing hospital providing direct patient care. (b) Must maintain a business office within the boundaries of the State of I exas. (c) 1vlust abide by all federal, state, and local laws. (d) Will only deploy staff upon receipt and under the terms of the State Mission Assignment as described in Section 2: Activations & Documentation. (e,) Will only deploy Resource employed staff as follows: (i) EMS personnel must be currently certified or licensed in "Texas at the EM'T-Basic level or above and who have no disciplinary actions pending or under investigation that the Resource is aware of. (ii) Registered Nurses must be currently and routinely practicing in an acute care environment providing direct patient care and who have no disciplinary actions pending or under investigation that the Resource is aware of. (iii) Physicians must be affiliated with a healthcare Resource (either directly or through a physician's group) and have no disciplinary actions pending or under investigation that the Resource is aware of (iv) Any other clinical staff must be employed by a healthcare Resource in a position with the same scope of practice as their role in the activation and have no disciplinary actions pending or under investigation that the Resource is aware of. (v) Any non -clinical staff must be also employed by the Resource. (f) Will deploy the personnel ordered by DSI IS in configurations designated by the State Mission Assignment. (g) Medical procedures undertaken by deployed EMS staff be according to protocols approved by the Resource's Medical Director The MMIJ will be under the dilection of a physician on site. (h) Must assure detailed records of expenditures and time spent by deployed staff are complete, accurate, and have adequate supporting documentation. (i) Will ensure deployed personnel are self-sufficient for 72 hours or as detailed in the State Mission Assignment and should be aware that they could be living in field conditions. (j) Must ensure that all deployed staff carries proof of his or hers individual certifications and/or licenses as a'I'exas healthcare professional and a form of picture identification with them at all times. (k) Must assume responslbilit) for liability claims, malpractice claims, disability claims, workers compcnsati m claims, attorneys' fees, and other incurred costs. 7 'I'X EMT' MOA 09/25/2012 9) Mobile Medical Units, Equipment, and Supplies: A) Purpose: 1) 'I he purpose of this section is to establish a mechanism for Mobile Medical Units (` MMtJs"), which may include clinical personnel, support personnel, equipment or any combination of the above, per the State Mission Assignment, to be deployed for any purpose defined in the TX EM'I'I' MOA I3) Description: 1) The Lead RAC may enter into Subcontracts with other RACs, hospitals, governments, or other entities to provide one or more MMUs to meet the Purpose of this TX I;M'I'I: MOA including: (a) Non -critical care capability (b) Emergent care capability (c) Temporary healthcare infrastructure (d) Isolation capability, or as a (e) Physical structural asset C) Minimum requirements for a fully staffed MMU: 1) (Clinical and Support staffing) are: (a) Sixteen bed capacity (b) Staffing of teams sufficient to support MMU operations based on capability as defined in the State Mission Assignment (c) Minimum staffing per shift for each team includes clinical and logistics staffing as defined for the primary mission in the State Mission Assignment and consistent with DSIIS typing. (d) Clinical Staff may include MD/Dos, RNs, Paramedics/I;M'I's, MLPs (PAs/APRNs), Pharmacy Technicians, clerks, etc. (e) Logistics/Support Staff- to support maintenance, electrical, IIVAC, communications, transportation, set-up, and demobilization as agreed to by I)SI IS at the time of mobilization (1) Supplies sufficient to fulfill primary mission per the State Mission Assignment for 72 hours (g) The Resource will schedule its MMI1 assets and estimated deployment costs In Appendix D 10) AMI3US(es) A) Pui pose: 1) I'hc purpose of this section is to establish a mechanism whereby properly staffed ind equipped AMI3US(es) may be deployed for mass transportation and/or care of sick and/or injured persons or to provide aid in a pending or actual disaster as provided in this TX EM'I'I' MOA. 13) Description: 1) I'he Lead RAC may enter into MOIJ/MOAs with IFS Providers, hospitals, RACs or governmental entities which: (a) Possess an AM13US(cs). (b) I'he AMI311S will he licensed as a Specialty EMS Vehicle by DSI IS. 8 'I'X I?MTIr MOA 09/25/2012 (c) The AMBUS will be staffed with trained and credentialed staff sufficient to maintain operations (d) The minimum staffing per shift are: (i) Properly licensed vehicle driver (ii) Crew Chief (fit) 2 — Paramedics (iv) 2 — EMTs or above (e) The Resource will provide its AMI3TIS asset(s) list and estimated deployment cost with Appendix 13. 11) Miscellaneous A) State Law. If state law applicable to the relationship between Resource and Lead RAC contains additional or more stringent requirements than federal law regarding any aspect of P111 privacy, then the Parties agree to comp'} with the higher standard contained in applicable state law. 13) Consideration. Each Party recognizes that the promises it has made in this Agreement shall, henceforth, he relied upon by the other Party in choosing to continue or commence a business relationship with the other Party C) Modification. This Agreement may only be modified through a writing signed by the Parties and, thus, no oral modification hereof shall be permitted. The Parties agree to take such action as is necessary to amend this Agreement from time to time as may he required by federal or state law. I)) Acceptance of Mission. Each Party understands and agrees that a Resource has the ability to accept or reject a Mission. E) Notice to Lead RAC. Any notice required under this Agreement to be given to the Lead Resource shall he made in writing to: Lead RAC: Attn. to: Address: City, State: Zip: With copy to: Attn. to: Address: City, State: Zip: North Central Texas Trauma Regional Advisory Council Executive Director 600 Six Flags Drive, Suite 160 Arlington, `Texas 76011 The Remington I,aw Group, Pile William P. Remington 416 West 8th Street Dallas, 'I exas 75208 9 'I'X FMTIMOA 09/25/2012 I+) Notice to Resource. Any notice required under this Agreement to be given Resource shall be made in writing to: City of Fort Worth: City Manager 1000 Throckmorton Street Fort Worth, TX 76102 With copy to: Fort Worth Fire Department: Fire Chief 1000 Throckmorton Street Fort Worth, TX 76102 G) Governing Law. This Agreement will be governed by and construed in accordance with the laws of the State or I exas without regard to choice of taw. H) Transfer or Assignment 1) This agreement may be assigned or transferred, if a new bead RAC is assigned. without requiring the Agency to resign the agreement. I'he newly designated bead RAC will send a notice to the Resource with a current printed copy of the MOA and a NOTICE advising the Resource of the new Lead RAC 2) The NOTICE will include the new Lead RAC information (SECTION 11-E) 3) "I'he NOTICE will also include a new Signature section as executed by the, new I,cad RAC 4) Otherwise, neither party may assign, transfer, delegate, or sublicense any of its rights or obligations under this Agreement without the prior written consent of the other party I) Entire Agreement. This Agreement constitutes the complete agreement between the Parties relating to the matters specified in this Agreement, and supersedbs all prior repiesentations of agreements, whether oral or written, with i espcct to such matters. No oral modification or waiver of any of the pro isions of this Agreement shall he binding on either Party. 10 TX EMTF MOA 09/25/2012 IN WITNESS WHEREOF and acknowledging acceptance and agreement of the foregoing, the Parties affix their signatures hereto Lead RAC: NCTTRAC North Central Texas Trauma Regional Advisory Council Lead RAC Legal Name Signature 40.4bsix I kTmatt ‘C•Sts Printed Name Sio•eatia, bota Title 2-15 Date CI�, or Fais Wor kesource Legal Name arure es W- 1),2riteks Printed Name AL*4* C;47 Manager Title 097* 3/. Me Date SOS OFFICIAL RECORD CITY SECRETARY FT. WORTH, TX 11 • TX EMT!: MDA 09/25/2012 APPENDIX A The TX EMIT reimbursement rates effective during the term of this Agreement for the various Assets described are listed below. Any Asset not described or any deviation from these amounts should be specifically included in the State Mission Assignment at the time of the deployment. 1) Allowable costs for EMS Assets: A) Lead RAC will coordinate reimbursement of a base rate for: BLS, ALS, and MICLJ ambulances as per the current fee schedule. B) with Volunteer Personnel: 1) Lead RAC will reimburse: (a) I abor Rate of: (i) $20.00 for paramedic, (ii) $17.50 for EMT Intermediate, (iii) $13.50 for EM I' bask for each hour the staff are deployed, plus overtime at time and a half the established rate fot any hours worked over 8 within each 24 hour period. (b) Personal Cost: Maximum of $50 00 per crew member per deployment ( Total Of $100.00 per two member crew) for items needed for the crew to be self-sufficient during the deployment. These items may include food, water, and personal care items. The DSI IS EMS Licensed Provider must keep receipts for these items and must submit them to the Lead RAC when the DSIIS EMS Licensed Provider submits an invoice to the I ead RAC. C) Resource with Paid Personnel: 1) Lead RAC will reimburse: (a) Actual labor costs (b) Fringe benefits for two (2) crew members per ground ambulance. (c) The overtime cost (1/2 time) of staff required to fill the regular scheduled shift of staff deployed. (d) Personal Cost: Maximum of $50.00 per crew member per deployment (Total of $100.00 per two member crew) for items needed for the crew to he self-sufficient during the deployment. 'These items may include food, water, and personal care items. The DSI IS EMS Iicensed Provider must keep receipts for these items and must submit them to the Lead RAC when the DSI IS EMS Licensed Provider submits an invoice to the Lead RAC (e) Repair of damaged equipment, if applicable. Ambulance Reimbursement Table. Item Vehicle - one Ambulance Per Diem based on $35.00 per day/per person of a two person Amb. crew or six person AMBIJS crew Medical Supplies Cost Based on d•iily rates (I3I,S $240.00 per d•ry each)(AI,S $288.00 per day each)(MICtJ or AMI3(JS $360.00 per day each) Reimbursement Rates Metric Per hour Per hour Per hour Per hour I)LS $35.00 $2.92 $10.00 $47.92 AI,S MICU $40.00 $40.00 $2.92 $2.92 $12.00 $15.00 $54.92 1 $57.92 j 12 Item AMI3US Per Diem -- based on $35.00 per day/per person of a six person AMI3US crew Supplies Reimbursement Rates 'I'X Emu: MOA 09/25/2012 APPENDIX 13 The "I'X EMIT reimbursement rates effective during the term of this Agreement for the various Assets described are listed below. Any Asset not described or any deviation from these amounts should be specifically included in the State Mission Assignment at the time of the deployment. 1) Allowable costs for AMBUS Assets: A) Lead RAC will Reimburse: 1) Uncompensated salary costs of staff to "make ready the Assets for deployment once the State Mission Assignment has been issued, documentation must he submitted for proof of payment; 2) Actual hourly labor costs of' deployed staff plus fringe benefits 3) The overtime cost (1/2 time) -)1 staff required to backfill the regular scheduled shift of staff deployed 4) fuel; 5) Shipping/transportation fees; 6) Daily usage fee; 7) Actual cost for food and lodging will be reimbursed at the rates established by the State Comptroller; 8) Personal mileage from home to deployment site and return at a rate per mile as published by the State Comptroller for the time period specified or other specific travel costs; 9) Use of' rented vehicles will only be reimbursed at the rental rate as established by the State Comptroller or as approved in the State Mission Assignment; 10) Use of personal vehicles will only he reimbursed for mileage using the mileage rates currently in effect at the time of deployment as published by the State Comptrollcr's office. No other expenses refried to the use of personal vehicles will be reimbursed; 11) Repair of damaged equipment; if applicable. AMBUS Reimbursement 'fable Purl lour $40.00 $8.75 $15.00_ $63.75 Per Day $960.00 $210.00 $360.00 $1530.00 I3 Tx EM'I'F MOA 09/25/2012 APPENDIX C The TX IMP' reimbursement rates effective during the term of this Agreement for the various Assets described are listed below. Any Asset not described or any deviation from these amounts should bu specifically included in the State Mission Assignment at the time of the deployment. 1) Allowable costs for Professional Staff Assets: A) I ead RAC will reimburse: 1) P'.id staff: (a) Actual hourly labor cost of deployed staff plus fringe benefits. (b) Personal mileage from home to deployment site and return at a rate per mile as published by the State Comptroller for the time period specified or other specific travel costs (airline travel, rental vehicle, parking, etc.). (c) The overtime cost (1/2 thne) of staff requited to till the regular scheduled shift of staff deployed 2) Vehicles (a) Resource -owned vehicles that will be used during deployment for field supervision or team leaders will he reimbursed at daily FEMA established rate per hour for vehicle type. (b) Use of rented vehicles will only be reimbursed at the rental rate as established by the State, Comptroller or as approved in the State Mission Assignment; (c) Ilse of personal vehicles will only be reimbursed for mileage using the mileage rates currently in effect at the time of deployment as published by the State Comptroller's office. No other expenses related to the use of personal vehicles will he reimbursed. 3) Support trailers or Vehicles (a) Resource owned vehicles or trailers that are not supervisor vehicles may be used by deployed personnel if approved on the State Mission Assignment. Rcimbui sement for these Assets shall be reimbursed at the current FEMA published rate. 4) Repair of damaged equipment; if applicable. 14 TX I;M'I'I MOA 09/25/2012 APPENDIX D "1'he TX FM`I'E reimbursement rates effective during the term of this Agreement for the carious Assets described are listed below. Any Asset not described or any deviation from these amounts should he specifically included in the State Mission Assignment at the time of the deployment. 1) Allowable costs for MMU Assets: A) bead RAC will Reimburse: 1) Uncompensated salary costs of staff to "make ready" the Assets for deployment once the State Mission Assignment has been issued, documentation must he submitted for proof of payment; 2) Uncompensated salary costs of staff deployed with assets for set up and management; documentation must be submitted for proof of payment; 3) Actual hourly labor costs of deployed staff plus fringe benefits; 4) The overtime cost (1/2 time) of staff if required to backfiI l the regular scheduled shift of staff deployed. 5) Fuel; 6) Shipping/transportation fees; 7) Daily usage fee; 8) Actual cost for food and lodging will be reimbursed at the rates established by the State Comptroller; 9) Personal mileage from home to deployment site and return at a rate per mile as published by the State Comptroller lot the time period specified or other specific travel costs; 10) Use of rented vehicles will only be reimbursed at the rental rate as established by the State Comptroller or as approved in the State Mission Assignment. 11) Use of personal vehicles will only he reimbursed for mileage using the mileage rates currently in effect at the time of deployment as published by the State Comptroller's office. No other expenses related to the use of personal vehicles will be reimbursed 12) Supplies used; and 13) Repair of damaged equipment; if applicable. 15 TX I ;NI'I't MOA 09/25/2012 Appendix E I)F,FINITIONS Ambulance -- an EMS vehicle that is licensed as an "ambulance" in the State of 'Texas to the level designated or an EMS vehicle from another state that has been given legal authority by the State of Texas to operate as licensed ambulance in Texas during the current event. Ambulance Strike "Team (AST) - a configuration of five like -typed Ambulances with an Ambulance Strike Team header. ASTs are typed by capability. Ambulance Strike 'Team header (ASTI,) -- an AS'I'h credentialed EMS individual, approved by I)SI-IS, assigned to function in a supervisory capacity over EMS resources (usually ASTTs), with appropriate, separate transportation. AMBIJS — an Ambulance Bus which is licensed as a "specialty vehicle" ambulance in the State of Texas. Assets — collectively all personnel, equipment, supplies, and services that may he deployed, utilized, or coordinated by the Parties under this TX EMIT MOA, including RAC staff. Contractor an organization that is a Contractor with DSI IS for the purposes of managing the I Iospital Preparedness Program in a 'Trauma Service Area. Ueployed Assets -- any Asset activated to respond to a State Mission Assignment. District Disaster Committee .- as defined by the 'Texas Government Code, it is the coordination point for the disaster districts within the State and the point of local coordination between an RMO(' and the Governor s Division of Emergency Management Incident Command Structure. DSI IS —Texas Department of State I lealth Services I;rnergency or Disaster --- any incident declared as an "emergency" or a "disaster" by the State of 'Texas May be used independently or collectively. EMS Personnel - an EMS professional licensed or certified by DSI IS, to include EMT, EM'T-I, EMT-P and Licensed Paramedics. EMS Provider an agency Iicensed in the State of Texas to provide ambulance service. In -place Assets - any Asset activated in support of the RAC 's ability to implement this TX EM'I'I' MOA. 16 'fX EM'I'P MOA 09/25/2012 Lead RAC Activation the initiation of the terms of this TX EMTI: MOA by a State Mission Assignment from the Lead RAC as authorized 111 Section 2 A of this document. Lead RAC State Mission Assignment --- the mobilization paperwork authorizing the response of the Resource as specified in the State Mission Assignment. Mission — the Asset specified objectives, goals, etc. as outlined in the State Mission Assignment, including but not limited to destinations, tasks, cc mmand support roles, etc. Mobile Medical Unit (MMU)---, a rapidly deployable structure capable of providing medical care in a 16 bed configuration, to include the infrastructure support and staff for its set up and operational use. An MMU alone does not automatically include a clinical staff. A "Staffed MMU" includes the clinical staff configuration. Parties — the Parties to this TX EM'I'I: MOA, specifically the designated, signing Lead RAC and the Resource. RAC — an authorized Regional Advisory Council designated by DSI IS Regional Medical Operations Center (RIVIOC) - - a regional medical coordination center, managed at the RAC or multi -RAC (EMIT region) level, in coordination with the Governor's Division of' Emergency Management Incident Command Structure to include local DDCs, the SOC, and the DSI IS State Medical Operations Center (SMOG;). RN Strike Team (RNST) -- a configuration of five like -typed Registered Nurses of which one will be the RN Strike Team header. RNS'I's are typed by capability. Staffed MMU - a clinically staffed, 16 bed capable, rapidly deployable Mobile Medical Unit, utilizing the staffing requirements as approved by DSI IS State Mission Assignment -- paperwork authorizing mobilization response of Resources Subcontract(s) -- the agreement(s) made by the RACs to implement this TX I:MTF MOA or manage I1PP resources. Subcontractor -- a Resource that is a subcontractor with a RAC for the purposes of implementing this TX FMTI4 MOA or managing I IPP resources. Training Events — an event approved under this TX EM"IT MOA to activate Assets for the purposes of readiness and education of team members. TX EMIT' MOA — this specific Memorandum of Agreement Warning Ordertheinitial written notice of a pending State Mission Assignment from DSI IS notifying the Lead RAC of the possibility of Activation and possible request to deteimine the initial availability of Assets. 17 I'X EIVIFF MOA 09/25/2012 Appendix F Asset Information 'l'hc following information is needed lot planning purposes only. These numbers are not binding. Each Agency will have the option to accept or reject each deployment. Each Agency will also determine the quantity of assets available to deploy. Please do NOT provide minimal numbers but provide the most accurate estimate of what could be deployed when called upon, if in a scenario that will have minimal impact locally. The planning numbers should allow Coastal agencies to give real numbers of what could send to a wildfire understanding the same assets could not be provided in a hurricane situation. Agencies will have the ability to deploy more or less than the planning numbers 1 listed below. Agency Name Provider / License # 1 Agency Mail Address Agency City 1 Agency 'Lip Agreement Signatory I What Position (and above) can approve Deployments Deployment Contact r Deployment Email I to: Expiration / Renewal Datc Does each deployable EMS Una have a VHF Mobile radio (Not 1 1T) with '1 X InterOp channels? VII1t-Yes) ( VI IF -No) 18 # TX MICUs # Type 1 AI,S w/ I lazMat # Type I1 ALS r non-I-IazMat It 'Type III I3I,S w/ IlazMat # Type IV BI,S non-HazMat # Strike 'Team I,eader ## Command Center # AMBUS # Mobile Medical Unit # Support Trailer # M-IS'I' (Medical Incident Support) # ASM (Ambulance Staginb Manager) 1 r�. TX mu: MOA 09/2.5/2o 12 # 'Task Force headers # I?MS Group Supervisors # Doctors ## Mid -bevel Practitioners ## Nurses # Paramedics (not on 1 1 1 AMI3/AMBIJS) # I Intermediate(not on j AMI3/AMBIJS) f# EMT-I3asic (not on AMB/AMBIJS) ## 'Tech # Clerk # Logistical C',r ewman If Command Staff 19